Sometimes, after the death of a loved one, it can be a real struggle to adapt to life without them. On the one hand we can recognise that we need to build a different (or new) life. On the other hand we don’t want to let go of life as it previously was.

However, over time we invariably begin to realise that we need to choose a new life. This can sometimes be a very difficult decision. It’s not uncommon to feel that building a new life means forgetting the loved one or ‘getting over’ the loved one. It can feel that we would be betraying them. Often we can recognise that this is not the case, but sometimes this can be difficult for someone and therapy can invariably help here. The aim of the therapy is to learn how to incorporatethe memories and experiences we have of a loved one into our present life, rather than learn how to forget them.

In cognitive behavioural therapy (CBT), we recognise that our thoughts and behaviour play a key role in forming the new path.

Thoughts

Recent research has suggested that frequent worrisome thoughts about the future can impact the adjustment process (Eisma et al 2017). This makes sense given the amount of research that has shown that that thoughts that bring about a sense of hope can be really valuable at this time. However, it is easy to get caught up in worrisome thoughts. It is common for people to think that the pain will not ease, that they will not find a renewed sense of purpose in life, their loved one will be forgotten and that they will not be happy again. The aim of CBT is to help others recognise that this need not be the case. Knowing others have gone on to find happiness again can form the basis of this hope, and letting yourself know these things are possible is a start.

Behaviours

Involving ourselves in life without our loved one is also important for the adjustment process. This can be difficult, but thinking of activities to engage with as part of our new life is a step. One of the unhelpful cycles we can get into is to spend a lot of time indoors thinking about our loved one. It can be important to give ourselves time for this. However, it’s equally it’s important for us to show ourselves that life is continuing and we can continue. Therefore, engaging in some activities can be really valuable too and help us begin a different life. These activities can be things you’ve done before, or can be new interests. They can be anything from going for a coffee with a friend or doing an activity never previously considered. It may feel difficult to start something new, and indeed continue with old activities. This is where others may be of help – perhaps go with someone else first of all, or just go for a very short time.

During the initial grieving period, there will be times that things feel easier and times that will feel harder. At times you may feel like progress is slow. But, over time things will hopefully feel a little easier as we naturally adjust to our new life….. without forgetting our old one.

As always, please feel free to ask me any questions. I will be more than happy to help.

For this month’s blog I thought I’d write about an area that causes a lot of people difficulty – sleeping difficulties – and just give a couple of very quick tips that I hope will help.

It is very common for people I see to be suffering from sleep difficulties. However, often that is not the reason they contacted me. Instead it is feelings of low mood or heightened anxiety that they’ve been suffering with. One of the questions I will always ask in an assessment though is around sleep. Simply put, although sleep may not be the primary concern, poor sleep can certainly be a contributing factor in maintaining depression and anxiety.

There are a couple of proven methods to combat sleep. The first is medication. There is no doubt that one can take prescribed sleeping tablets to help get to sleep. However, these tablets are commonly prescribed for only a short period – simply because they can be so addictive and can easily be relied upon as the ‘only’ way to sleep. Therefore, when they are not available, the sleep problem returns. Their effectiveness also wanes with time.

The second proven method is psychological therapy, namely Cognitive Behavioural Therapy (CBT). CBT for insomnia has been assessed in over 100 RCTs (randomised controlled trials – known as the ‘gold standard’ of research). The results show that on average 70% of people with even very long term poor sleep obtain lasting benefit from the treatment. CBT explores and works on two areas:

– the mental (or cognitive) factors associated with insomnia, such as the ‘racing mind’.
– the behavioural element that is hindering the development of a ‘pro-sleep’ routine and stopping one achieving a strong connection between bed and successful sleep.

The aim of CBT is therefore to use cognitive techniques to help with the former and behavioural techniques to work on the latter.

Cognitive

The cognitive techniques will often explore the anxious thoughts that may be hindering sleep. For example, typical thought processes that can hinder sleep are those focusing on:

– planning or problem-solving (this is what we do in the day and stimulates / switches on the brain)
– how we are not yet asleep and the effect this will have on your day ahead. This typically generates anxiety, and the brain typically thinks that if we’re feeling anxious then we must be in some sort of danger – and therefore sleep is not advisable)
– sounds in our environment that appear different – again this ‘switches on the brain

Techniques adopted may look at unhelpful thinking styles and we would work together on how you can tackle these. Mindfulness approaches can be helpful here to help us observe, rather than engage with our troublesome thoughts. We may also explore the content of thoughts and use diaries or thought records to help. Each area will typically involve a different technique, tailored to you.

Behavioural

In relation to behavioural techniques, the aim here is to focus on strengthening the relationship between your bed and sleep. There are a number of behaviours that can keep us awake and stop this connection growing. Given this, I thought it would be helpful if I laid out a few behavioural tips that may help improve your sleep. There’s loads of these about, but I thought I’d focus on some that many find helpful:

– Try to go to bed and get up at the same time – even at weekends! This helps your body get into a natural rhythm
– Avoid caffeine and nicotine for at least 4-6 hours before bed as they stimulate the brain.
– Avoid alcohol. Same as above, it’s best to avoid alcohol for at least 4-6 hours before sleep. It’s worth noting here that even though some people think alcohol helps them to get to sleep, alcohol negatively affects the quality of the sleep.
– Avoid ‘blue light’ in bed. Laptops, ipads, smartphones all emit ‘blue’ light. The brain can interpret this as meaning it’s the morning and so should ‘wake up’.
– Try not to clock watch. It often leads to ‘Oh no, I’ve only x hours till I wake up’. This creates anxiety and wakes up the brain. Try to cover any clocks and rely on an alarm to tell you when to wake up.
– Have a bedtime routine. Train the brain to know when it is bed time. You can create sleeping rituals such as 15 minutes of light-reading before sleep, or sitting down with a mug of tea before bed (caffeine-free of course!)

Finally, sleep difficulties can be very frustrating and challenging, so I would not want anyone to think that I’m implying that just by doing the above it’ll be fixed. Indeed, you may be reading this and thinking you’ve tried the above techniques to little effect. Whether you’d tried them or not, I’d be happy to speak to you further and discuss whether CBT could be of benefit.

Around this time of year, many children and young adults struggles with the stress of exams. If you’re going through this, or you know someone who is, my aim is to help reduce your / their stress levels and help this period to be as productive as possible.

Often when a child, adolescent or adult comes to see me for exam stress, they are displaying a number of signs of anxiety and/or low mood including:

Thoughts
– Negatively predicting how the exams will go and what will happen if they do not do as well as they hope
– Self-critical thoughts about what it’ll mean about them if they do not do well. Also self critical thoughts when they’re struggling to learn/understand something they are revising.

These thoughts, feelings, behaviours and physiological symptoms may be interrelated. However, whilst it can be easy for someone on the outside to see an unhelpful cycle a student is engaging in, the student themselves may be too enmeshed in the cycle to recognise what is occurring – i.e., unable to see the wood for the trees. This is where an objective person (family member, friend, teacher or therapist) can be of help.

In using Cognitive Behavioural Therapy (CBT), my aim is to help a student recognise and work on unhelpful cycles they may be engaging in and come up with alternative cycles. The goal would never be to delete stress – after all, a level of stress can help us motivate ourselves – instead, the goal is to lower this stress level so that it does not negatively impact on performance and feel overwhelming.

Tips
Here are a few quick tips I hope will help.

1. Aim for ‘good enough’
When revising, sometimes we can get caught in the perfectionism cycle. For example, we may want to ensure we’ve understood something 100% before we move onto the next topic. Or we may not even try to understand something because we do not believe we’ll be able to fully understand it.

If you’re struggling with this, allow yourself to be ok with not knowing all of something, and just to know enough. Speak to yourself in a kind and compassionate way when you find yourself struggling to understand something and ask yourself how you would motivate someone who was also struggling with this.

2. Healthy body, Healthy mind
It may look like revising takes up little energy (after all, you’re just sitting down!), but the brain requires lots of fuel during revision. Therefore, try to ensure you’re putting the right amount of nutrients into your body (see http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell-plate.aspx) for a healthy plate)

Also exercise can be helpful – a short brisk walk can be really helpful and help the brain step back from the stress of exams / revising.

3. Reward yourself
We all work well with rewards. Allow yourself time off from revision to do fun stuff – this’ll help motivate you to continue revising, and also keep your mood levels up.

4. Sleep well
Get a sleep routine in place. Aim to go to bed and get up at the same time each day and give yourself a minimum of an hour to wind down in the evening before you go to bed – this’ll help the quality of your sleep.
If you revise as well as you can, then how you do is irrelevant. You’ve strived to do as well as you can and so therefore if:
– a question comes up that’s not your forte
– you have a random brain freeze
– you have a dodgy examiner
– you’re ill on the day

then you have still strived to do your best and you can not do any more than that.

Do get in touch if you’d like further support with exam stress. I can offer support to either the student or their family members.

Welcome to the first blog on my site. I often get asked questions regarding diffierent aspects of my work, for example surrounding the specific therapies, the conditions I treat, the commonality of particular symptoms (to name but a few). My plan is to use this blog space to give you information about these and to keep you up to date with research in the field of cognitive behavioural therapy, mindfullness, acceptance and committment therapy and Eye Movement Desensitisation Reprocessing. Please do feel free to get in touch if you have any questions and I’d be happy to speak to you.